The Perception of Cancer Risk in Patients with Barrett's Esophagus

描述（由申请人提供）： 巴雷特食管（BE），定义为食管肠上皮化生的发展，是一种易患食管腺癌的癌前病变。无异型增生BE患者的癌症发病率较低，约为0.005例/患者-年。我们以前已经证明，BE患者平均大大高估了他们患癌症的风险，并且风险的高估与资源利用增加的趋势有关，例如内窥镜检查和诊所就诊。本申请的目的是：1）在一项多中心研究中评估非异型增生BE受试者的食管腺癌感知风险，2）评估这些受试者的风险感知与资源利用之间的关系，3）开发一种基于互联网的自我指导教学干预措施，在随后的RO 1申请中对BE受试者进行管理。研究者是经验丰富的临床研究人员，在行为科学专家的帮助下，有着长期的BE研究记录。这项规划补助金将提供一种机制，以确认从初步数据中观察到的关于在巴雷特食管背景下高估患者癌症风险的结果，并将研究风险认知与医疗保健利用之间的关联。它还将提供一种手段，在一个经过充分验证的医疗保健行为模型的框架内，开发一种旨在解决患者对风险误解的干预措施。该补助金将允许细化疾病定义，结果测量，样本量和分析计划，并解决随后应用该补助金开发的干预措施的多中心试验的可行性问题。由此产生的研究应用程序将评估健康相关的生活质量，健康相关的焦虑和医疗保健利用作为结果。

DESCRIPTION (provided by applicant): Barrett's esophagus (BE), defined as the development of intestinal metaplasia in the esophagus, is a premalignant condition that predisposes to adenocarcinoma of the esophagus. The incidence of cancer in the setting of BE without dysplasia is low, approximating 0.005 cases/patient-year. We have previously demonstrated that patients with BE on average greatly overestimate their risk of development of cancer, and that over-estimation of risk was associated with a trend toward increased utilization of resources, such as endoscopy and clinic visits. The objectives of this application are: 1) to assess the perceived risk of esophageal adenocarcinoma in subjects with non-dysplastic BE in a multi-center study, 2) to assess the relationship between risk perception and the utilization of resources in these subjects, and, 3) to develop an internet-based based, self-directed teaching intervention to be administered to subjects with BE in a subsequent RO1 application. The investigators are experienced clinical researchers with a long record of investigation in BE, aided by experts in behavioral sciences. This planning grant would provide a mechanism to confirm observations from preliminary data regarding the overestimation of patients' cancer risk in the setting of Barrett's esophagus, and would examine the association between risk perception and healthcare utilization. It would also provide the means to develop an intervention designed to address patients' misunderstandings of risk, in the framework of a well-validated model of healthcare behavior. This grant will allow refining of disease definitions, outcome measures, sample size, and analysis plans and to address feasibility issues of a subsequent multi-center trial applying the intervention developed in this grant. The resultant study application will assess health-related quality of life, health-related anxiety and healthcare utilization as outcomes.